scholarly journals Delirium and post-discharge dementia: results from a cohort of older adults without baseline cognitive impairment

2019 ◽  
Vol 48 (6) ◽  
pp. 845-851 ◽  
Author(s):  
Flavia Barreto Garcez ◽  
Daniel Apolinario ◽  
Flavia Campora ◽  
Jose Antonio Esper Curiati ◽  
Wilson Jacob-Filho ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Clinical History ◽  
University Hospital ◽  
Proportional Hazard ◽  
Post Discharge ◽  
Preventable Risk Factor ◽  
Admission Data ◽  
Incident Dementia

Abstract Objectives to investigate the association between delirium occurrence in acutely ill older adults and incident dementia after hospital discharge. Methods retrospective cohort study examining acutely ill older adults aged +60 years and consecutively admitted to the geriatric ward of a tertiary university hospital from 2010 to 2016. Inclusion criteria were absence of baseline cognitive decline on admission and documented clinical follow-up of +12 months after discharge. Admission data were collected from our local database, including results from a standardized comprehensive geriatric assessment completed for every patient. Pre-existing cognitive decline was identified based on clinical history, CDR and IQCODE-16. Delirium was diagnosed using short-CAM criteria, while post-discharge dementia after 12 months was identified based on medical records’ review. We used competing-risk proportional-hazard models to explore the association between delirium and post-discharge dementia. Results we included 309 patients. Mean age was 78 years, and 186 (60%) were women. Delirium was detected in 66 (21%) cases. After a median follow-up of 24 months, 21 (32%) patients who had experienced delirium progressed with dementia, while only 38 (16%) of those without delirium had the same outcome (P = 0.003). After adjusting for possible confounders, delirium was independently associated with post-discharge dementia with a sub-hazard ratio of 1.94 (95%CI = 1.10–3.44; P = 0.022). Conclusion one in three acutely ill older adults who experienced delirium in the hospital developed post-discharge dementia during follow-up. Further understanding of delirium as an independent and potentially preventable risk factor for cognitive decline emphasizes the importance of systematic initiatives to fight it.

scholarly journals Social isolation, rather than loneliness, is associated with cognitive decline in older adults: the China Health and Retirement Longitudinal Study

2021 ◽  
pp. 1-8
Author(s):  
Bin Yu ◽  
Andrew Steptoe ◽  
Yongjie Chen ◽  
Xiaohua Jia
Keyword(s):  
Older Adults ◽  
Longitudinal Study ◽  
Cognitive Function ◽  
Episodic Memory ◽  
Cognitive Decline ◽  
Social Isolation ◽  
Mental Status ◽  
Chinese Older Adults ◽  
Confounding Variables

Abstract Background Social isolation and loneliness have each been associated with cognitive decline, but most previous research is limited to Western populations. This study examined the relationships of social isolation and loneliness on cognitive function among Chinese older adults. Methods This study used two waves of data (2011 and 2015) from the China Health and Retirement Longitudinal Study and analyses were restricted to those respondents aged 50 and older. Social isolation, loneliness, and cognitive function were measured at baseline. Follow-up measures on cognitive function were obtained for 7761 participants (mean age = 60.97, s.d. = 7.31; male, 50.8%). Lagged dependent variable models adjusted for confounding factors were used to evaluate the association between baseline isolation, loneliness, and cognitive function at follow-up. Results Loneliness was significantly associated with the cognitive decline at follow-up (episodic memory: β = −0.03, p < 0.01; mental status: β = −0.03, p < 0.01) in the partially adjusted models. These associations became insignificant after additional confounding variables (chronic diseases, health behaviors, disabilities, and depressive symptoms) were taken into account (all p > 0.05). By contrast, social isolation was significantly associated with decreases in all cognitive function measures at follow-up (episodic memory: β = −0.05, p < 0.001; mental status: β = −0.03, p < 0.01) even after controlling for loneliness and all confounding variables. Conclusions Social isolation is associated with cognitive decline in Chinese older adults, and the relationships are independent of loneliness. These findings expand our knowledge about the links between social relationships and the cognitive function in non-Western populations.

scholarly journals Lower Risk for Dementia Following Adult Tetanus, Diphtheria and Pertussis (Tdap) Vaccination

2021 ◽  
Author(s):  
Jeffrey F Scherrer ◽  
Joanne Salas ◽  
Timothy L Wiemken ◽  
Christine Jacobs ◽  
John E Morley ◽  
...  
Keyword(s):  
Lower Risk ◽  
Protective Effects ◽  
Proportional Hazard ◽  
Veterans Health ◽  
Cox Proportional Hazard ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Nonspecific Effects ◽  
Reduce Risk

Abstract Background Adult vaccinations may reduce risk for dementia. However it has not been established whether tetanus, diphtheria, pertussis (Tdap) vaccination is associated with incident dementia. Methods Hypotheses were tested in a Veterans Health Affairs (VHA) cohort and replicated in a MarketScan medical claims cohort. Patients were ≥65 years of age and free of dementia for 2 years prior to index date. Patients either had or did not have a Tdap vaccination by the start of either of two index periods (2011 or 2012). Follow-up continued through 2018. Controls had no Tdap vaccination for the duration of follow-up. Confounding was controlled using entropy balancing. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between Tdap vaccination and incident dementia in all patients and in age sub-groups (65-69, 70-74, ≥75 years of age). Results VHA patients were, on average, 75.6 (SD±7.5) years of age, 4% female, and 91.2% were white race. MarketScan patients were 69.8 (SD±5.6) years of age, on average and 65.4% were female. After controlling for confounding, patients with, compared to without Tdap vaccination, had a significantly lower risk for dementia in both cohorts (VHA: HR=0.58; 95%CI:0.54 - 0.63 and MarketScan: HR=0.58; 95%CI:0.48 - 0.70). Conclusions Tdap vaccination was associated with a 42% lower dementia risk in two cohorts with different clinical and sociodemographic characteristics. Several vaccine types are linked to decreased dementia risk, suggesting that these associations are due to nonspecific effects on inflammation rather than vaccine-induced pathogen-specific protective effects.

scholarly journals Cognitive decline and alcohol consumption adjusting for functional status over a 3-year period in French speaking community living older adults

2018 ◽  
Vol 41 (2) ◽  
pp. e177-e184 ◽  
Author(s):  
Helen-Maria Vasiliadis ◽  
Marie-Christine Payette ◽  
Djamal Berbiche ◽  
Sébastien Grenier ◽  
Carol Hudon
Keyword(s):  
Older Adults ◽  
Alcohol Consumption ◽  
Cognitive Decline ◽  
Functional Status ◽  
Repeated Measures ◽  
Service Use ◽  
High Functioning ◽  
French Speaking ◽  
Changing Patterns

AbstractBackgroundThe effect of alcohol consumption on cognitive decline is not clear. We aimed to study the association between alcohol consumption and cognitive functioning controlling for functional heath status.MethodsA total of 1610 older adults with a score ≥26 on the Mini-Mental State Examination (MMSE) were followed to assess the change in scores at the 3-year follow-up. Information on alcohol consumption as well as socio-demographic, lifestyle, psychosocial and clinical factors, as well as health service use were assessed at baseline and 3-year follow-up interviews. Linear mixed models with repeated measures were used stratifying by functional status.ResultsClose to 73% reported consuming alcohol in the past 6 months, of which 11% were heavy drinkers (≥11 and ≥16 drinks for women and men). A significant decrease in MMSE scores was observed in low functioning non-drinkers (−1.48; 95% CI: −2.06, −0.89) and light to moderate drinkers (−0.99; 95% CI: −1.54, −0.44) and high functioning non-drinkers (−0.51; 95% CI: −0.91, −0.10).ConclusionsAlcohol consumption did not contribute to cognitive decline. Cognitive decline was greater in individuals reporting low functional status. Research should focus on the interaction between changing patterns of alcohol consumption and social participation in individuals with low and high functioning status.

scholarly journals Clinical and laboratory follow-up after hospitalization for COVID-19 at an Italian tertiary care center

2021 ◽  
Author(s):  
Michele Spinicci ◽  
Iacopo Vellere ◽  
Lucia Graziani ◽  
Marta Tilli ◽  
Beatrice Borchi ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Care Center ◽  
Tertiary Care ◽  
University Hospital ◽  
Tertiary Care Center ◽  
Persistent Symptom ◽  
Post Discharge

Abstract We evaluated 100 post-acute COVID-19 patients, a median of 60 days (IQR 48-67) after discharge from the Careggi University Hospital, Italy. Eighty-four (84%) had at least one persistent symptom, irrespective of COVID-19 severity. A considerable number of hospital re-admission (10%) and/or infectious diseases (14%) during the post-discharge period was reported.

scholarly journals Association of Early Post-Discharge Follow-Up by a Primary Care Physician and 30-Day Rehospitalization Among Older Adults

2014 ◽  
Vol 30 (5) ◽  
pp. 565-571 ◽  
Author(s):  
Terry S. Field ◽  
Jessica Ogarek ◽  
Lawrence Garber ◽  
George Reed ◽  
Jerry H. Gurwitz
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Primary Care Physician ◽  
Care Physician ◽  
Post Discharge

scholarly journals SAT-LB115 Metformin-Use Is Associated With Slowed Cognitive Decline and Reduced Incident Dementia in Older Adults With Type 2 Diabetes Mellitus: The Sydney Memory and Ageing Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Katherine Samaras ◽  
Steve Makkar ◽  
John D Crawford ◽  
Nicole A Kochan ◽  
Wei Wen ◽  
...  
Keyword(s):  
Older Adults ◽  
Heart Disease ◽  
Executive Function ◽  
Older People ◽  
Cognitive Decline ◽  
Community Dwelling ◽  
Incident Dementia ◽  
Ageing Study ◽  
Global Cognition ◽  
Rate Of Decline

Abstract Background Metformin use in diabetes has been associated with both increased and decreased dementia rates in observational studies of people with diabetes. Objective: To examine changes in global cognition and specific cognitive domains over 6 years in older adults with diabetes treated with metformin, compared to other glucose lowering medications, and to people without diabetes. Methods Data were examined from the Sydney Memory and Ageing Study, a prospective observational study of 6 years duration of 1037 non-demented community-dwelling elderly aged 70-90 at baseline, derived from a compulsory electoral roll. Neuropsychological testing was performed every 2 years with domain measures of memory, executive function, language, visuospatial function, attention and processing speed and a composite of global cognition. Data were analysed by linear mixed modelling, including age, sex, education, body mass index, heart disease, diabetes, hypertension, stroke, smoking and apolipoprotein E ε4 carriage as covariates. Results: At baseline, 123 participants had diabetes (DM) with 67 receiving metformin (DM+MF) who were similar in demographics to those not receiving metformin (DM-noMF) and those without diabetes (no-DM). Participants with diabetes had higher BMI, lower HDL- and LDL-cholesterol and more prevalent heart disease, hypertension and smoking, compared to no-DM. Over 6-years, DM+MF participants had significantly slower rates of decline in global cognition and executive function, compared to DM-noMF, adjusted for covariates. The rate of decline for each cognitive domain was similar between DM+MF and controls. No impact was found in analyses examining interactions with sex, ApoEε4 carriage or hyperlipidemia. No difference was found in the rate of decline in brain volumes between the groups over 2 years. Incident dementia was significantly higher in DM-noMF, compared to DM+MF (adjusted OR 5.29 [95% CI 1.17-23.88], p,0.05), whereas risk of incident dementia was similar between DM+MF and participants without diabetes. Conclusions: In older people with diabetes receiving metformin, rates of cognitive decline and dementia were similar to that found in people without diabetes and significantly less than that found in people with diabetes not receiving metformin. Large randomized studies in people with and without diabetes are required to determine whether these associations can be attributed to metformin alone or if other factors explain these observations. Future studies will clarify if this cheap and safe medication can be repurposed for prevention of cognitive decline in older people.

scholarly journals Illiteracy, dementia risk, and cognitive trajectories among older adults with low education

Neurology ◽  
2019 ◽  
Vol 93 (24) ◽  
pp. e2247-e2256 ◽  
Author(s):  
Miguel Arce Rentería ◽  
Jet M.J. Vonk ◽  
Gloria Felix ◽  
Justina F. Avila ◽  
Laura B. Zahodne ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Independent Effect ◽  
Growth Curve Models ◽  
Cox Proportional Hazards Models ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Low Education

ObjectiveTo investigate whether illiteracy was associated with greater risk of prevalent and incident dementia and more rapid cognitive decline among older adults with low education.MethodsAnalyses included 983 adults (≥65 years old, ≤4 years of schooling) who participated in a longitudinal community aging study. Literacy was self-reported (“Did you ever learn to read or write?”). Neuropsychological measures of memory, language, and visuospatial abilities were administered at baseline and at follow-ups (median [range] 3.49 years [0–23]). At each visit, functional, cognitive, and medical data were reviewed and a dementia diagnosis was made using standard criteria. Logistic regression and Cox proportional hazards models evaluated the association of literacy with prevalent and incident dementia, respectively, while latent growth curve models evaluated the effect of literacy on cognitive trajectories, adjusting for relevant demographic and medical covariates.ResultsIlliterate participants were almost 3 times as likely to have dementia at baseline compared to literate participants. Among those who did not have dementia at baseline, illiterate participants were twice as likely to develop dementia. While illiterate participants showed worse memory, language, and visuospatial functioning at baseline than literate participants, literacy was not associated with rate of cognitive decline.ConclusionWe found that illiteracy was independently associated with higher risk of prevalent and incident dementia, but not with a more rapid rate of cognitive decline. The independent effect of illiteracy on dementia risk may be through a lower range of cognitive function, which is closer to diagnostic thresholds for dementia than the range of literate participants.

Medical Complications Predict Cognitive Decline in Nondemented Hip Fracture Patients—Results of a Prospective Observational Study

2018 ◽  
Vol 31 (2) ◽  
pp. 84-89 ◽  
Author(s):  
Juliana Hack ◽  
Daphne Eschbach ◽  
Rene Aigner ◽  
Ludwig Oberkircher ◽  
Steffen Ruchholtz ◽  
...  
Keyword(s):  
Cognitive Decline ◽  
Influencing Factors ◽  
Hip Fractures ◽  
Mental State ◽  
Mini Mental State Examination ◽  
University Hospital ◽  
Medical Complications ◽  
Consecutive Series ◽  
State Examination

Objective: The aim of this study was to identify factors that are associated with cognitive decline in the long-term follow-up after hip fractures in previously nondemented patients. Methods: A consecutive series of 402 patients with hip fractures admitted to our university hospital were analyzed. After exclusion of all patients with preexisting dementia, 266 patients were included, of which 188 could be examined 6 months after surgery. Additional to several demographic data, cognitive ability was assessed using the Mini-Mental State Examination (MMSE). Patients with 19 or less points on the MMSE were considered demented. Furthermore, geriatric scores were recorded, as well as perioperative medical complications. Mini-Mental State Examination was performed again 6 months after surgery. Results: Of 188 previously nondemented patients, 12 (6.4%) patients showed a cognitive decline during the 6 months of follow-up. Multivariate regression analysis showed that age ( P = .040) and medical complications ( P = .048) were the only significant independent influencing factors for cognitive decline. Conclusions: In our patient population, the incidence of dementia exceeded the average age-appropriate cognitive decline. Significant independent influencing factors for cognitive decline were age and medical complications.

scholarly journals Motoric cognitive risk syndrome and incident dementia in older adults from the Québec NuAge cohort

2020 ◽  
Author(s):  
Olivier Beauchet ◽  
Harmehr Sekhon ◽  
Liam Cooper-Brown ◽  
Cyrille P Launay ◽  
Pierrette Gaudreau ◽  
...  
Keyword(s):  
Older Adults ◽  
Successful Aging ◽  
Walking Speed ◽  
Community Dwelling ◽  
Slow Walking ◽  
Cognitive Risk ◽  
Incident Dementia ◽  
Cognitive Complaint ◽  
Slow Walking Speed

Abstract Background The co-occurrence of slow walking speed and subjective cognitive complaint (SCC) in non-demented individuals defines motoric cognitive risk syndrome (MCR), which is a pre-dementia stage. There is no information on the association between MCR and incident dementia in Québec’s older population. Objective The study aims to examine the association of MCR and its individual components (i.e. SCC and slow walking speed) with incident dementia in community-dwelling older adults living in the province of Québec (Canada). Design Québec older people population-based observational cohort study with 3 years of follow-up. Setting Community dwellings. Subjects A subset of participants (n = 1,098) in ‘Nutrition as a determinant of successful aging: The Québec longitudinal study’ (NuAge). Methods At baseline, participants with MCR were identified. Incident dementia was measured at annual follow-up visits using the Modified Mini-Mental State (≤79/100) test and Instrumental Activity Daily Living scale (≤6/8) score values. Results The prevalence of MCR was 4.2% at baseline and the overall incidence of dementia was 3.6%. MCR (Hazard Ratio (HR) = 5.18, with 95% confidence interval (CI) = [2.43–11.03] and P ≤ 0.001) and SCC alone (HR = 2.54, with 95% CI = [1.33–4.85] and P = 0.005) were associated with incident dementia, but slow walking speed was not (HR = 0.81, with 95%CI = [0.25–2.63] and P = 0.736). Conclusions MCR and SCC are associated with incident dementia in NuAge study participants.

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